A case of solid variant type of pancreatic serous cystadenoma mimicking islet cell tumor

We report a case of the solid variant type of pancreatic serous cystadenoma in which the very small size of the cyst on ultrasonography and computed tomography made distinguishing this tumor from other hypervascular solid tumors difficult. Recognizing the imaging features of high signal intensity on heavily T2-weighted image on MR may be helpful for correctly diagnosing the solid variant type of pancreatic serous cystadenoma.     

Pancreatic calcifications in malignant islet cell tumors.

Of 623 cases of malignant pancreatic tumor seen at University of Chicago hospitals over the last 30 years, 23 cases of malignant islet cell tumor were found (8 additional cases were found in the literature). Calcification, found in 2 of these cases, was characteristically discrete and nodular (calcifications found in chronic pancreatitis are typically diffuse, multiple, and punctuate). At least 7 of the 10 cases of islet cell tumor with calcification were malignant. Slow growth of the tumor, with calcified metastases, strongly suggests the diagnosis of malignancy; this combination of findings has been established in 3 cases. In 73 cases of benign islet cell tumor, no calcifications were found.     

Discrimination of unilocular macrocystic serous cystadenoma from pancreatic pseudocyst and mucinous cystadenoma with CT: initial observations

PURPOSE: To compare the computed tomographic (CT) appearance of pancreatic unilocular macrocystic serous cystadenoma, mucinous cystadenoma, and pseudocyst to determine if there are findings that assist in the differential diagnosis. MATERIALS AND METHODS: CT findings in 33 patients (24 women, nine men; age range, 18-84 years; mean age, 41 years) with unilocular pancreatic lesions (macrocystic serous cystadenoma, n = 12; mucinous cystadenoma, n = 11; pseudocyst, n = 10) were retrospectively and jointly reviewed by two blinded observers. Twenty-three patients underwent helical CT, which included pancreatic and portal venous phase imaging with delays of 40 seconds and 65 seconds, respectively, after contrast material injection. Ten patients underwent conventional (nonhelical) CT. The number, size, location, and contour of lesions were reviewed, along with wall thickness and enhancement and other signs of pancreatic and peripancreatic involvement. Diagnosis was based on lesion resection (n = 22) or on a combination of cytologic findings, biochemical markers, and tumor markers (n = 11). The Fisher exact test was used to analyze the results. RESULTS: Three of four CT findings were independently specific for macrocystic serous cystadenoma: location in the pancreatic head, lobulated contour, and absence of wall enhancement. When two of these four criteria were used in combination, 83% (10 of 12) of patients with unilocular macrocystic serous cystadenoma were identified. When three or four of these criteria were used, a specificity of 100% was achieved. Location in the pancreatic head (P <.05), lobulated contour (P <.005), and lack of wall enhancement (P <.005) were specific for macrocystic serous cystadenoma in comparison with mucinous cystic tumor. Lobulated contours (P <.005) were specific for macrocystic serous cystadenoma in comparison with pseudocyst. Other CT findings were not helpful in distinguishing between the three types of lesions. CONCLUSION: A combination of CT findings is helpful in making the diagnosis of pancreatic unilocular macrocystic serous cystadenoma.     

胰腺浆液性囊腺瘤的MRI特征

目的探讨胰腺浆液性囊腺瘤的MRI表现特征。方法回顾性分析10例胰腺浆液性囊腺瘤的MRI表现,包括肿瘤位置、瘤体直径、最大囊直径、分隔和中央瘢痕情况及胰胆管情况等影像学征象。结果 7例微囊型浆液性囊腺瘤:5例位于胰头部,2例位于胰体尾部。瘤体直径2.9～8.1cm,平均为5.1cm;最大囊直径0.9～6.8cm,其中5例小于2cm,平均为2.5cm,7例均可见分隔,6例可见中央瘢痕。增强扫描分隔均见强化,部分瘢痕强化,囊性成分均无强化。1例胰管轻度扩张,胆管无受累。3例少囊型浆液性囊腺瘤:2例位于胰头部,1例位于胰尾部。瘤体直径2.2～3.5cm,平均为2.8;最大囊直径2.2～3.0cm,平均为2.7cm,2例单囊,1例非单囊,无中央瘢痕。增强扫描分隔有强化,囊性成分无强化。3例胰管均无扩张,胆管无受累。结论典型的胰腺浆液性囊腺瘤MRI表现可以大致做出诊断,对于疾病的治疗,有一定的参考价值,但是最终诊断及分型还有赖于病理检查。     

Pancreatic islet cell transplantation: an update for interventional radiologists

Pancreatic islet cell transplantation is a promising cellular-based therapy for type 1 diabetes mellitus. This procedure involves portal venous injection of islet cells and affords 1-year insulin independence in as many as 80% of recipients. Although transplant surgeons represent historical drivers of islet therapy, requirement for image guidance and transcatheter techniques has fostered collaboration with interventional radiologists, who are positioned to play a significant role in clinical performance of islet transplantation and in basic science research in this field. This review article aims to familiarize interventional radiologists with islet cell transplantation patient selection, procedure technique, clinical outcomes, and future clinical and research avenues.     

胰腺浆液性微囊性囊腺瘤CT和MRI表现

目的 分析胰腺浆液性微囊性囊腺瘤(SMCA)的CT和MRI影像表现特征.方法 回顾性分析经手术病理证实的17例胰腺SMCA的CT及MRI表现,包括肿瘤位置、长径、分隔、增强表现及有无钙化、中央瘢痕、胰胆管扩张等影像表现.结果 17例SMCA:1例同时行CT和MR检查,10例行CT检查,6例MR扫描(其中2例同时行MRCP).病变位于胰头2例,胰颈2例,胰腺体尾部13例.肿瘤长径1.7~14 cm,平均5.2 cm.16例可见分隔,1例分隔显示欠佳,9例可见中央瘢痕.增强扫描分隔及瘢痕强化,囊性成分均无强化.6例可见远端主胰管扩张.结论 胰腺SMCA有一定的影像学特征,多表现为分叶状结节或肿物,具有多发小囊,囊腔多<2 cm,囊与囊之间见多发纤维分隔,增强扫描后纤维分隔明显强化,但低于胰腺组织.中央瘢痕是其特征性表现,在MR上多表现为T1WI及T2WI等或稍低信号.典型的胰腺SMCA根据CT和MRI表现可以做出明确诊断.     

Pancreatic mucinous cystadenoma communicating with the main pancreatic duct on MRI

We report a case of a mucinous cystadenoma of the pancreas communicating with the main pancreatic duct. To our knowledge, this is the first case in which a communication between the mucinous cystadenoma and the main pancreatic duct could be demonstrated by MRI.Mucinous cystic neoplasms (MCNs) of the pancreas are low-grade tumours and represent approximately 10% of pancreatic cysts and 1% of pancreatic neoplasms. MCN is a clinical and pathologic entity, distinctly different from intraductal papillary mucinous neoplasms (IPMNs). The absence of communication of the cyst with the pancreatic duct has been used by some as a criterion for diagnosing MCNs and differentiating these neoplasms from IPMNs [1].We report a case of a mucinous cystadenoma communicating with the main pancreatic duct. To our knowledge, this is the first case in which a communication has been demonstrated on MRI.     

胰腺巨大黏液性囊腺瘤1例

<正> 女,43岁,3月前自感上腹部疼痛不适,可扪及一包块,无恶心呕吐,无腹胀腹泻,疼痛以夜间为著,未予治疗。近日来,感疼痛加重,包块较前增大,来院诊治。实验室检查无异常。MRI检查示胰尾部巨大椭圆形肿块以长T_1、长T_2信号为主,内有条状、片状更长T_1、稍短T_2信号。大小约9.9 cm×11.5 cm×10.8 cm。增强扫描病灶内部及壁条形强化(见图1～3)。手术所见:肿块位于腹膜后,与胰体尾关系密切,大小约10 cm×20 cm,术中诊断胰腺囊肿。病理:胰腺黏液性囊腺瘤(见图4)。     

胰腺巨囊型浆液性囊腺瘤的MSCT表现及其诊断

目的：探讨胰腺巨囊型浆液性囊腺瘤的MSCT特点,提高诊断准确性。方法：13例经手术病理证实为胰腺巨囊型浆液性囊腺瘤的患者,术前行上腹部MSCT平扫及双期增强扫描。结果：13个病灶均为类圆形囊性灶,呈均匀薄壁,轮廓清、欠规则,大部分未见壁结节(12例),其中2例呈外生性生长,最大径2.0～6.5 cm,平均3.3 cm。...     

经阴道超声对卵巢浆液性囊腺瘤的诊断意义

 目的 评价经阴道超声对卵巢浆液性囊腺瘤的诊断意义,探讨进一步提高诊断符合率的可能性。方法 对33例经病理证实的卵巢浆液性囊腺瘤的超声表现及诊断进行分析总结。结果 33例卵巢浆液性囊腺瘤患者均为单发。其中23例为卵巢单房样囊肿,经阴道超声做出提示性诊断20例,2例误诊为卵巢子宫内膜囊肿,1例误诊为卵巢囊实性包块,诊断符合率为86.9%（20/23）;10例为单侧卵巢多房样囊肿,超声做出提示性诊断6例,4例误诊为卵巢黏液性囊腺瘤,诊断符合率为60%（6/10）。结论 对于卵巢单房样浆液性囊腺瘤,经阴道超声可较为准确地做出诊断,而对于多房样浆液性囊腺瘤,尤其是囊液内伴有点状回声者,经阴道超声较难做出正确的提示。     

CT of serous cystadenoma of the pancreas and mimicking masses

OBJECTIVE: The purpose of this article is to illustrate the varied CT appearances of serous cystadenoma of the pancreas and of masses that mimic serous cystadenoma. CONCLUSION: Serous cystadenomas of the pancreas have a wide range of CT findings. Familiarity with the varied CT appearances and awareness of the diagnostic limitations of CT are important for accurate diagnosis and management of serous cystadenoma of the pancreas.     

Choriocarcinoma of the ovary associated with mucinous cystadenoma

We report choriocarcinoma of the ovary associated with mucinous cystadenoma in a 54-year-old postmenopausal woman, the first reported case of this condition. Doppler ultrasonography, computed tomography, and magnetic resonance imaging showed hypervascularity of the tumor that corresponded to the area of choriocarcinoma within the multilocular cyst. The patient exhibited multiple pulmonary metastases and died of intracerebral hemorrhage.     

Malignant islet cell tumor of the pancreas associated with portal venous thrombus

In this report, CT and MR findings of a malignant islet cell tumor of the pancreas associated with tumor thrombus in the portal vein is presented. Imaging findings revealed diffuse involvement of the body and tail of the pancreas by the tumor. The most unusual finding was that this invasive tumor was an insulinoma.     

131I uptake in a benign serous cystadenoma of the ovary

A patient with well-differentiated thyroid carcinoma had a whole body scan using 5 mCi ¹³¹I which demonstrated abnormal uptake of ¹³¹I in a palpable pelvic mass. Approximately 24 years ago the patient had a total thyroidectomy followed by ¹³¹I treatment. The histologic examination of the mass was consistent with serous cystadenoma of the ovary. No thyroid tissue or teratoma was identified. The mechanism for the unusual uptake of ¹³¹I in a benign ovarian tumor is not clear, and the differential diagnosis of metastatic thyroid cancer is briefly reviewed.     

CT differentiation of solid serous cystadenoma vs endocrine tumor of the pancreas

Aim

To differentiate between solid serous cystadenoma (SSCA) and endocrine tumor (ET) of the pancreas using dynamic CT findings.

Materials and methods

Between 2001 and 2008, there were 3 SSCA and 15 ET surgically resected in our institute, for whom preoperative multidetector-row CT were available. Various CT features were retrospectively evaluated by two radiologists in consensus for the differentiation between the two entities. Delay time for early and delayed phase images were 40 and 180 or 240 s, respectively. For qualitative assessment, density of the tumors relative to the surrounding parenchyma was evaluated, along with other characteristic features. In patients for whom digital data were available, CT values of the tumors were measured, and quantitative assessment was also performed. Relative and absolute washout rate (RWR and AWR, respectively) were also calculated.

Results

Mean sizes of the two groups were similar. Tumors were seen as low density area more frequently in SSCA than in ET on unenhanced CT (3/3 vs 1/14), and also on the delayed phase image (2/3 vs 0/14) (p < 0.05). Fibrous capsule was observed more frequently in SSCA (2/3) than in ET (0/14). CT value of the tumor on unenhanced CT was significantly lower, and RWR was higher in SSCA than in ET (p < 0.05, Mann–Whitney's U test). The difference in delayed phase CT density and AWR did not reach statistically significant level.

Conclusion

Unenhanced and enhanced CT findings may be of value in differentiation between SSCA and ET.     

Pancreatic cystadenoma. Angiographic and histologic findings illustrated by two cases

Two cases of pancreatic cystadenoma are presented, demonstrating the typical angiographic and histologic pattern as given in previous literature. Although computed tomography and ultrasound examinations may be useful [11], angiography seems to play a decisive role in establishing the diagnosis, demonstrating the localization and extent of the tumor, and permitting the possible differentiation of benign and malignant lesions.     

Heterotopic bone in the ovary associated with a mucinous cystadenoma

Bone formation in the ovary, with the exception of developing in the setting of a mature cystic teratoma, is exceedingly uncommon. We report a case of bone formation within a mucinous cystadenoma of the ovary. A 19-year-old active duty female presented with an asymptomatic pelvic mass; sonographic imaging revealed a 5.7-cm complex right adnexal mass. A laparoscopic cystectomy was performed. Pathologic evaluation of the cyst revealed a mucinous cystadenoma. Contained within several of the thick fibrous septae were areas of well-formed bone. Although a benign finding, bone formation and associated fibrosis may lead to sonographic findings of concern during the evaluation of patients with a pelvic mass.